某些抗菌剂可能会引起过敏


  【24drs.com】根据最近一篇研究,曝露于常见的抗菌剂triclosan和parabens与致敏反应显著有关;抗菌剂和吸入性过敏原与食物致敏之间有浓度相关关联。Triclosan和parabens都是环境荷尔蒙(EDCs)。
  
  约翰霍普金斯过敏与临床免疫科的Jessica H. Savage医师等人,在6月18日过敏与临床免疫学期刊期刊在线发表一项全国健康调查之现有资料的分析结果,作者们使用了大型的全国代表性样本研究EDCs和过敏性疾病之间的关系,尿液EDC值用作为曝露的生物标记。
  
  作者们使用了2005-2006年「美国国家健康与营养调查」的资料,共包括10,348名病患,其中859人是8-16岁孩童,有完整的EDC值分析资料;吸入性过敏原和食物过敏定义为对空气过敏原或食物出现至少一种特定免疫球蛋白E(IgE)阳性反应(≧0.35 kU/L)。
  
  校正年纪、性别、种族、尿液肌酸酐值、收入等因素之后,研究者确认吸入性过敏原过敏的机率随著triclosan和propyl与butyl parabens值而显著增加。比较尿液triclosan值前三分之一和后三分之一,吸入性过敏原的校正胜算比(OR)是1.73 (95%信心区间[CI],1.11 - 2.69;P = .02),类似地,propyl paraben之校正OR为2.04 (95% CI,1.12 - 3.74;P = .02),butyl paraben则是1.55 (95% CI,1.02 - 2.33;P = .02)。
  
  作者们发现,男性的致敏风险增加最为显著;EDC和过敏性气喘、哮喘病史或总IgE值之间无关联。
  
  作者们表示,这项回溯横断面研究有其固有的限制,横断面研究的另一个可能限制是,过敏病患更可能会使用含有triclosan和parabens的产品。
  
  「Allergy and Asthma Consultants」的Mark Holbreich医师表示,有趣的是,这篇研究继续支持我们在生命初期之曝露对于发生过敏之影响的观念,之前的横断面和前瞻流行病学研究显示菌群和过敏性疾病之间的关系。
  
  虽然承认目前的是初步研究,Holbreich医师很好奇「卫生假说的另一面」。他解释,卫生假说的传统理解是,某些孩童受到过敏原的保护,通常,这些受保护孩童的特征是来自农场、接触到更广泛的菌群。研究者表示,这个农场效应可能是许多因素的结果。
  
  卫生假说也引起一些问题:为何某些孩童对于过敏原较具保护力,有些则是容易致病?虽然目前的理解是,孩童过敏原并没有关键的生物曝露,但Holbreich医师表示,这篇文章提出过敏孩童可能有化学物质暴露,而增加过敏反应发生的可能性。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6858&x_classno=0&x_chkdelpoint=Y
  

Exposure to Antibacterials May Predispose to Allergies

By Lara C. Pullen, PhD
Medscape Medical News

June 20, 2012 — Exposure to the common antimicrobials triclosan and parabens was significantly associated with allergic sensitization, according to a recent study. The concentration-dependent association was found between the antimicrobials and aeroallergen and food sensitization. Both triclosan and parabens are endocrine-disrupting compounds (EDCs).

Jessica H. Savage, MD, from the Johns Hopkins Division of Allergy and Clinical Immunology, Baltimore, Maryland, and colleagues presented the results of an analysis of existing data from a national health survey in an article published online June 18 in the Journal of Allergy and Clinical Immunology. The authors used the large, nationally representative sample to investigate the relationship between EDCs and atopy. Urinary EDC levels were used as a biomarker of exposure.

The authors used data from the 2005 to 2006 National Health and Nutrition Examination Survey, which included a total of 10,348 patients, of whom 859 were children aged 8 to 16 years with complete data for the analysis of EDC levels. Aeroallergen and food sensitization were defined by the presence of at least 1 positive (?0.35 kU/L) specific immunoglobulin E (IgE) level to an aeroallergen or food.

After adjusting for age, sex, race/ethnicity, urinary creatinine level, and income, the investigators determined that the odds of aeroallergen sensitization significantly increased with the level of triclosan and propyl and butyl parabens. Comparing the third vs the first tertile of urinary triclosan, the adjusted odds ratio (OR) for aeroallergen sensitization was 1.73 (95% confidence interval [CI], 1.11 - 2.69; P = .02). Similarly, the adjusted OR for propyl paraben was 2.04 (95% CI, 1.12 - 3.74; P = .02), and for butyl paraben it was 1.55 (95% CI, 1.02 - 2.33; P = .02).

The authors found that the increased risk for sensitization was most pronounced for men. There was no association between EDCs and a history of atopic asthma, wheeze, or total IgE level.

The authors acknowledge the limitation inherent in a retrospective, cross-sectional study. The cross-sectional study is also limited by the possibility that patients with allergy may be more likely to use products containing triclosan and parabens.

The 'Flip Side of the Hygiene Hypothesis'

Mark Holbreich, MD, FAAAAI, from Allergy and Asthma Consultants in Indianapolis, Indiana, spoke with Medscape Medical News about the article. "I think what's interesting is that it continues to support the idea that what we are exposed to early in life affects the development of allergies," Dr. Holbreich said. Previous cross-sectional and prospective epidemiological studies have demonstrated a relationship between bacterial flora and allergic disease.

Although acknowledging that the current study is preliminary, Dr. Holbreich was intrigued by the "flip side of the hygiene hypothesis." He explained that the traditional understanding of the hygiene hypothesis is that certain populations of children are protected from allergies. Typically, these protected children are characterized as children from farms who may be exposed to a wider variety of bacterial flora. Investigators acknowledge that this farm effect is likely the result of a combination of factors.

The hygiene hypothesis drives the question: Why are certain groups of children more protected and other children more vulnerable to allergies? Although the current understanding is that children with allergies are not having critical biological exposures, this article raises the possibility that children with allergies may be having chemical exposures that are creating a vulnerability to an allergic response, Dr. Holbreich said.

The study was supported by the National Institutes of Health. One author has consulted for Merck/UBC, has received grants from the National Institutes of Health, and has received payment for lectures and travel from Indoor Biotechnologies. One author has consulted for the Asthma and Allergy Foundation of America, has provided expert witness testimony for the National Institutes of Health, and has received royalties from UpToDate. One author has received grants from the National Institutes of Health. Dr. Savage and Dr. Holbreich have disclosed no relevant financial relationships.

J Allergy Clin Immunol. Published online June 18, 2012.

    
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